Daily costs of prostaglandin analogues as monotherapy or in fixed combinations with timolol, in Denmark, Finland, Germany and Sweden

BACKGROUND: To compare the daily costs of 3 prostaglandin analogues (bimatoprost, latanoprost, travoprost), alone, and associated with timolol in 4 European countries (Denmark, Finland, Germany, and Sweden). METHODS: Six glaucoma products were sampled by buying 5 bottles from 1 suburban pharmacy in each of the 4 countries. Drops were weighed by a single operator at 1 site according to standardized procedures. Residual drops were then counted. Unit bottle costs were estimated from tariff lists. Eye-drop weights were entered into a nested analysis of variance comprising drug, instillation day, country, the interaction, and a sample factor nested within the country factor. Effectiveness was represented by treatment failure rates estimated from a meta-analysis and a general practitioner survey. RESULTS: Every drug bottle contained sufficient drops to treat 1 patient for 28/31 days. Drop-size heterogeneity between countries was observed for bimatoprost and bimatoprost/timolol. Mean travoprost and travoprost/timolol drop-sizes were the smallest, and drop-counts per bottle were the lowest for latanoprost, or latanoprost/timolol. In all 4 countries annual costs were least for travoprost and travoprost/timolol. CONCLUSIONS: On taking into account drug costs and effectiveness, travoprost and travoprost/timolol were cheaper and more effective than latanoprost and latanoprost/timolol and were cheaper than bimatoprost and bimatoprost/timolol

Systems medicine and integrated care to combat chronic noncommunicable diseases

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems

de Kervasdoue J. et alii : La santé rationnée, la fin d'un mirage

Le Pen Claude. de Kervasdoue J. et alii : La santé rationnée, la fin d'un mirage. In: Politiques et management public, vol. 1, n° 1, 1983. pp. 212-214

Prévention de masse versus prévention à la carte. Le point de vue de l'économiste ?

Le propos qui suit s’attache tout d’abord à situer la place du thème de la prévention dans le débat public français avant d’envisager la question de sa « rentabilité » sociale. Après avoir envisagé ensuite la manière dont la prévention ciblée peut – ou non – modifier cette dernière, il se termine par la question des comportements individuels et collectifs, privés et publics, centrée à nouveau sur les éventuelles spécificités de la prévention ciblée qui constitue le thème général du séminaire...

Le prix du médicament en Europe : Anciens et nouveaux modèles

Le Pen Claude. Le prix du médicament en Europe : Anciens et nouveaux modèles. In: Revue d'économie financière, n°34, 1995. Le financement de la santé, sous la direction de Cyrille Piatecki. pp. 123-142

Réglementation des prix et formes de la concurrence dans l'industrie pharmaceutique

Price regulation and competition patterns in the ethical drug industry in france This article gives the results of an econometric modelization of the ethical drugs price and quantity determination institutionnal process for France. From price and promotion elasticities, it is shown that competition on the pharmaceutical market essentially occurs through promotion and product differenciation rather than through prices. A comparison with elasticities that has been measured in other institutionnal contexts, and the results of an analysis of the price dynamic of new chimical entities, drive to the conclusion that the mentioned competition patterns are in fact greatly determined by the price regulation process itself.Réglementation des prix et formes de la concurrence dans l'industrie pharmaceutique A partir de la mesure des élasticités-prix et des élasticités-promotion au sein d'un modèle économétrique retraçant, sur données transversales, le processus institutionnel de détermination des quantités et des prix des produits pharmaceutiques, on montre que la concurrence sur ce marché s'exerce peu par les prix et davantage par l'effort promotionnel. La comparaison de ces résultats avec ceux obtenus par d'autres auteurs dans des contextes institutionnels différents et les résultats d'une étude longitudinale de la dynamique des prix des innovations permettent de poser l'hypothèse que c'est le processus institutionnel de réglementation des prix lui-même qui est en grande partie à l'origine de cette forme de concurrence.Le Pen Claude. Réglementation des prix et formes de la concurrence dans l'industrie pharmaceutique. In: Revue économique, volume 39, n°6, 1988. pp. 1159-1192

Une évaluation du coût des politiques de création d'emplois publics

This article is an attempt to evaluate, theorically and empirically, the economic effect of a public policy of stabilization through public employment. Using the theorical framework by Bacon and Eltis who refer the economic problem of western world to the excessive spendings of public administrations and following their division of the economy into a productive sector and an unproductive one, we show that a shift in public employment involves a double cost for the productive sector : a "financial cost" equal to the ressources unproductively absorbed and a "real" cost corresponding to the opportunity cost of the value non generated in the productive sectors by workers transfered. Nevertheless, the empirical measurement of these both costs for years 1969-1978 in France, shows that this burden is not likely to be responsible for the slow down of economic growth, at least in the short term : the financial cost is in fact much inferior than the "apparent cost" (wages) of public employment since public employees assume a share of their own financing. Moreover, in a situation of excess of supply in the labor market, the opportunity cost tends to decrease near zero.This article is an attempt to evaluate, theorically and empirically, the economic effect of a public policy of stabilization through public employment. Using the theorical framework by Bacon and Eltis who refer the economic problem of western world to the excessive spendings of public administrations and following their division of the economy into a productive sector and an unproductive one, we show that a shift in public employment involves a double cost for the productive sector : a "financial cost" equal to the ressources unproductively absorbed and a "real" cost corresponding to the opportunity cost of the value non generated in the productive sectors by workers transfered. Nevertheless, the empirical measurement of these both costs for years 1969-1978 in France, shows that this burden is not likely to be responsible for the slow down of economic growth, at least in the short term : the financial cost is in fact much inferior than the "apparent cost" (wages) of public employment since public employees assume a share of their own financing. Moreover, in a situation of excess of supply in the labor market, the opportunity cost tends to decrease near zero.Le Pen Claude. Une évaluation du coût des politiques de création d'emplois publics. In: Politiques et management public, vol. 1, n° 1, 1983. pp. 25-47

Health Insurance, Access to Care and Income Redistribution

Nous développons un modèle « welfariste » dans lequel la demande collective d’assurance-maladie s’explique principalement par un motif de solvabilité : l’assurance-maladie n’a pas pour principale fonction de traiter l’aversion au risque d’agents solvables mais de permettre à des individus trop pauvres pour acquitter le coût des soins d’avoir accès à ceux-ci. Cette dimension redistributive de l’assurance-maladie, curieusement négligée dans la littérature, permet d’interpréter différemment les « effets pervers » d’une couverture maladie intégrale. La croissance de la consommation médicale qu’elle entraîne ne s’explique pas nécessairement par des comportements de « hasard moral » et il n’existe pas nécessairement de perte de bien-être collectif imputable à un « excès » de couverture assurantielle.We develop a "welfarist" model in which the collective demand for health insurance is mainly explained by a solvability motive : health insurance does not have for principal function to treat the risk aversion of solvent agents but to make it possible to individuals who are too poor to assume the cost of care to have access to those. This redistributive dimension of health insurance, curiously neglected in the literature, makes it possible to interpret differently the "perverse effects" of an integral insurance coverage. The growth of medical consumption that it involves does not necessarily explain by a "moral hazard" effect and there is not loss of collective well-being ascribable to an "excess" of insurance coverage.ou

Emplois publics et distribution des revenus

Public employment and distribution of income Claude Le Pen This paper investigates the influence of jniblic expenditure on distribution of income through the labour market. The demand of labour from public administrations exercices a differentiel effect on each workers group on a labour market with segmentation, and hence contributes ta determine the income gap. It is shown that, public production being held constant, each group lias interest to act politically to bias in its favours the actual « labour-mix ». Next, « labour-mix » being fixed, workers the government has the greatest « propen.sity to employ » have interest to support programs for extension of public production. The quantification of the lutter effect with french data, shows that its sense is anti-redistributive but its intensity is not likely to prevent others socio-economic factors from reducing the income gap.Ce texte s'intéresse à un canal de transmission peu connu des dépenses publiques vers les inégalités de revenus : le marché du travail. La demande de travail des administrations sur un marché segmenté exerce un effet différentiel sur les différents groupes et influence donc sur la structure salariale. On montre ainsi qu'à production publique donnée, chaque groupe de travailleurs a intérêt à agir pour biaiser en sa faveur le « complexe » de travail effectivement utilisé. A complexe donné, les travailleurs qui bénéficient de la plus forte « pro­pension à employer » de la part de l'Etat ont intérêt à favoriser la production publique. La quantification de ce dernier effet sur des données françaises montre qu'il est contre-redistributif mais que son intensité n'est toutefois pas telle qu'il puisse inverser la tendance à la fermeture de l'écart salarial dû à d'autres facteurs écono­miques et sociaux.Le Pen Claude. Emplois publics et distribution des revenus. In: Revue économique, volume 36, n°4, 1985. pp. 715-740